EXPERIMENT 4: Better Medicine by Default

As computerized systems begin to dominate the health care landscape, it is important to consider how these systems can be designed to aid physicians in making the best decisions and recommendations for their patients. Inherent in any system is the existence of defaults, which have been shown to influence decision making. In this project we explored how opt-in and opt-out defaults in electronic order templates may affect physicians’ treatment decisions.


We presented medical residents with order sets, showing either “opt-in” defaults (options visible but unselected) or “opt-out” defaults (options visible and preselected), and compared overall error rates and the severity of these errors.


As would be expected, opt-out defaults resulted in ordering more unnecessary items while opt-in defaults resulted in a greater level of order omission (not ordering something that the patient did need). And while errors were made with both default systems, revealing that the default display does indeed affect physicians’ decisions, the severity of these errors was low. Physicians were able to override incorrect defaults to an extent (and, reassuringly, succeeded making the right decisions when the risk of error would lead to extreme consequences), but they did not correct for the incorrect defaults in all cases. Due to the tradeoffs that doctors must make when maximizing accuracy and minimizing cognitive effort, these results highlight the importance of designing systems with smart defaults, particularly concerning low-impact items where defaults are less likely to be overridden.

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